Resident-Driven Quality Improvement Project in Perioperative Hand Hygiene

• Published in: Journal of patient safety Vol. 15; no. 4; pp. e44 - e47
• Main Authors: Pimentel, Marc Philip T, Feng, Aiden Yuzhe, Piszcz, Regina, Urman, Richard D, Lekowski, Robert W, Nascimben, Luigino
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-12-2019
• Subjects: Anesthesiologists; Anesthesiology; Cross Infection - prevention & control; Feedback; Guideline Adherence - standards; Hand Disinfection - standards; Hand Hygiene; Humans; Internship and Residency; Perioperative Period; Problem-Based Learning; Quality Improvement; Reminder Systems
• ISSN: 1549-8417; 1549-8425
• DOI: 10.1097/PTS.0000000000000282

OBJECTIVESThe goal of the project was to improve hand hygiene compliance in the perioperative setting while involving anesthesia residents in quality improvement. To achieve this goal, we facilitated direct trainee participation on patient safety and quality improvement initiatives. The result was a project for perioperative hand hygiene improvement conceived and led by anesthesiology residents.
METHODSAnesthesiology residents contributed project ideas and participated in problem-based learning discussions to develop several interventions for improving perioperative hand hygiene compliance. Interventions included electronic and laminated posters, reminder cards, monthly aggregated performance feedback, and a simulation-based hand hygiene workshop. Monthly hand hygiene compliance data were gathered during unannounced observations for a 29-month period. Run chart analysis and χ test were used to determine the impact of these interventions on compliance rates.
RESULTSA total of 1122 hand hygiene observations were made for 29 months. Run chart analysis showed a nonrandom shift and increasing trend during the postintervention period. The baseline hand hygiene rate was 68% (95% CI [65%–72%], n = 661), which increased to 79% post-intervention (95% CI [76%–83%], n = 461, P < 0.01).
CONCLUSIONSOur resident-led hand hygiene program used a multifaceted approach to drive sustained increases in perioperative hand hygiene compliance, while directly engaging house staff in quality improvement initiatives.